Wednesday, December 31, 2014

A Look Back at 2014

2014 was quite a year.   Thinking back to December 2013, I cannot believe that so much has happened.    Let’s take a look at the major HIT events that shaped 2014 and what they portend for 2015

Affordable Care Act - despite challenges with and state health insurance exchanges, the notion of moving forward with an open insurance marketplace and accountable care got traction.   The IT needed to meet the needs of the patient centered medical home, the ACO, and Care Management spawned a new type of software - the care management medical record.    Not many products exist and none are mature, but HIMSS was filled with promises of workflow engines, population health, and protocol driven care management tools.   2014 made it clear that the EHR is just a starting point and over time there will be a new generation of tools used by clinicians and non-clinician extenders to keep people healthy, not just record their encounters when they’re sick.   Hopefully we’ll see maturing products in 2015.

Meaningful Use/Standards - 2014 was really the first year we could take a look back at the Meaningful Use program.    I think we can conclude that Meaningful Use Stage 1 was generally perceived as a positive step, laying the foundation for EHR adoption by hospitals and professionals.   Stage 2 was aspirational and a few of the provisions - Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist.    The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.    At this point the only way out of the readiness/adoption challenge is to allow more time for the ecosystems to develop by changing the attestation period in 2015 to 90 days.    Although Direct/CCDA was a reasonable starting point for 2014, the future belongs to FHIR/REST/OAuth, which are going to be much easier to implement.    We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption

HIPAA Omnibus Rule - 2014 saw increased federal and state enforcement of the HIPAA Omnibus Rule with record fines for security breaches at a time when the nature of security attacks became increasingly sophisticated - witness the Home Depot, JP Morgan, and Target breaches as well as denial of service attacks on numerous healthcare and non-healthcare organizations.     Healthcare as an industry directed substantial resources toward improving the security protections of their networks in 2014.    It will be interesting to look back at this era in several years and ask the question if million dollar fines for stolen laptops/smartphones was a helpful policy or if other enablers such as the evolution of security technologies and culture change were more effective.

ICD10 - ICD10 was delayed until October 1, 2015 and it’s clear that stakeholders are divided about the concept.   One the hand, professional coders correctly identify that ICD9-CM is incomplete and does not include several important disease states.   On the other hand ICD10-PCS is so complex that it is unlikely clinicians will  not be able to produce the documentation needed to justify a code.   The cost to the country post implementation in lost productivity will be enormous.    If I could ask for a “do over” I would suggest that clinicians use SNOMED-CT to record clinical observations and that in a world of global capitated risk, not fee for service, the notion of using ICD for billing is no longer relevant.  ICD was intended as an epidemiological classification, not a billing vocabulary.   Only the United States uses ICD for billing and only the United States has proposed ICD10-PCS.   2015 will give us the next chapter in the debate.

In all industries, the concepts of social networking, mobile technology, analytics, and cloud hosting became increasingly important in 2014 for business and personal applications.    Healthcare has been slow to adopt these techniques but increasing cost pressures and new business models are motivating healthcare IT departments to embrace cloud services.   I believe that 2015 will be a tipping point, with increasing use of social networking concepts for care team communication, smart phones/tablets becoming the preferred tool for clinical work, real time decision support based on analysis of similar patients becoming mainstream, and cloud-based EHRs becoming essential for the agility of merging/changing organizations.  

2014 was a year of increasing stress for CIOs, accelerating workflow change, regulatory burden, unquenchable demand for automation, and rapid technology evolution.  2015 may see less new regulatory requirements, more mature products in the marketplace, and an increased role for the private sector to innovate.    As always, I remain optimistic for the future and am ready for the challenges ahead.


Anonymous said...

Hi John-

I'd really enjoy hearing more about your efforts to create the "CMMR" at BIDMC and private companies you've seen trying to address this need.

My personal opinion is that CMMRs are the ultimate "enabling technology"....that is, while they will create marginal direct value, they can empower the right teams helping the right patients improve quality and value of care. Ideally, a technology platform will be able to adapt for the multitude of care management models that are being adopted - whether telephonic, PCMH, home visit, or advanced illness management / palliative care.

Happy New Year!


Anonymous said...

Hi John - great recap. Wonder if you see Direct and FHIR as different tools for different purposes... Or is it "pick one"?
Happy new year, Rich